Provider Demographics
NPI:1366635351
Name:ORTHOPEDIC ASSOCIATES OF CORPUS CHRISTI
Entity Type:Organization
Organization Name:ORTHOPEDIC ASSOCIATES OF CORPUS CHRISTI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRECKENRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-854-0811
Mailing Address - Street 1:5917 CROSSTOWN EXPY
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78417-3504
Mailing Address - Country:US
Mailing Address - Phone:361-854-0811
Mailing Address - Fax:361-806-5040
Practice Address - Street 1:5917 CROSSTOWN EXPY
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78417-3504
Practice Address - Country:US
Practice Address - Phone:361-854-0811
Practice Address - Fax:361-806-5040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1126369-05Medicaid
TX0706430001Medicare NSC